Cataract surgery contracted out in Vancouver
CMAJ 2000;162:1187
Vancouver's Lions Gate Hospital has cut its waiting list for cataract surgery by 30% and freed up operating room time by contracting some services to a private clinic close to the North Shore hospital. The 3-month contracts began on a trial basis last July and will be assessed later this year.
The Northmount Eye Surgery Centre is well positioned to accept the steady flow of about 85 low-risk patients a month, says Clay Adams, spokesman for the North Shore health region, especially since 5 of the hospital's 6 ophthalmologists practise there. The cost of $550 per eye, which is paid by the hospital, includes an allowance for the clinic's overhead costs. Meanwhile, about 40 high-risk cataract operations are still performed at Lions Gate each month, but waiting times have dropped from almost 5 months to 3.
"It's going very well," says Adams. "Our patients are being seen on a much more timely basis and there is potential to speed up access even more. The benefits well outweigh the costs. It is an access issue, not a cost issue." Since 15% of local residents are older than 65, Adams expects demand for surgery will continue to grow; the move also creates more OR time at Lions Gate, allowing about 60 extra operations a month.
The health region did not seek the provincial health ministry's permission to contract for the cataract services. "All we are doing is changing the location of where the patients receive their service," says Adams. "We are not contravening the Canada Health Act because procedures are not based on people's ability to pay." The ministry has not expressed any concern about the arrangement; precedents for contracting out other services have already been set with hospitals in Washington State.
Adams, who worked with the Alberta Ministry of Health when contracting out was introduced there, had been anticipating some public outcry over the new arrangement, but says the response has been uniformly positive. — Heather Kent, Vancouver
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